Methods and apparatuses for cardiac resynchronization therapy mode selection based on intrinsic conduction

Abstract

Systems and methods for selecting a cardiac resynchronization therapy (CRT) mode involve sensing electrocardiogram (ECG) data for a patient, identifying a PR interval from the sensed ECG data, comparing the PR interval to a threshold, and selecting a CRT mode by selecting between a synchrony optimization mode and a preload optimization mode, the selection based on the comparison of the PR interval to the threshold. A synchrony optimization mode may be selected if the parameter is less than the threshold, and may optimize CRT for fusion between a left ventricular pulse and an intrinsic wavefront. The preload optimization mode may be selected if the parameter is greater than the threshold, and may optimize CRT for fusion between respective wavefronts of the left ventricular pace and a right ventricular pace.

Description

RELATED APPLICATIONS[0001]This application claims the benefit of Provisional Patent Application Ser. No. 61 / 102,455, filed on Oct. 3, 2008, to which priority is claimed pursuant to 35 U.S.C. §119(e) and which is hereby incorporated herein by reference.FIELD OF THE INVENTION[0002]The present invention relates generally to cardiac pacing devices and therapies, and more specifically, to systems and methods for selecting between cardiac resynchronization therapy modes.BACKGROUND OF THE INVENTION[0003]When functioning normally, the heart produces rhythmic contractions and is capable of pumping blood throughout the body. The heart has specialized conduction pathways in both the atria and the ventricles that enable the rapid conduction of excitation impulses (i.e. depolarizations) from the SA node throughout the myocardium. These specialized conduction pathways conduct the depolarizations from the SA node to the atrial myocardium, to the atrioventricular node, and to the ventricular myocar...

AI Technical Summary

Benefits of technology

This approach optimizes CRT delivery, improving cardiac output and efficiency by selecting the most appropriate therapy mode based on patient-specific conduction irregularities, as demonstrated by improved left ventricular ejection fraction, reduced ventricular dimensions, and increased peak oxygen consumption.

Problems solved by technology

Without the synchronization afforded by the normally functioning specialized conduction pathways, the heart's pumping efficiency is greatly diminished.

Patients who exhibit pathology of these conduction pathways can suffer compromised cardiac output.

Blockage in the conduction system can cause a slight or severe delay in the electrical impulses propagating through the atrioventricular node, causing inadequate ventricular contractions and filling.

As a result, the muscular walls of the affected ventricle do not contract synchronously (e.g., asynchronous contraction), thereby, reducing the overall effectiveness of the heart to pump oxygen-rich blood throughout the body.

Heart failure causes diminished pumping power of the heart, resulting in the inability to deliver enough blood to meet the demands of peripheral tissues.

Heart failure may affect the left heart, right heart or both sides of the heart, and may cause weakness, loss of breath, and build up of fluids in the lungs and other body tissues.

The reduced contractility decreases the cardiac output of blood and may result in an increased heart rate.

Particularly when the left or right ventricles are affected, the unsynchronized contractions can significantly decrease the pumping efficiency of the heart.

Images